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Varicose Veins

Varicose veins, also called a varix, varices or varicosities, are seen most often in the legs, although they can be found in other parts of the body. Most often, they appear as lumpy, winding vessels just below the surface of the skin. There are three types of veins: superficial veins that are just beneath the surface of the skin; deep veins that are large blood vessels found deep inside the muscles; and perforator veins that connect the superficial veins to the deep veins. The superficial veins are the blood vessels most often affected by this condition and are the veins that are visible when the varicose condition has developed.

The inside walls of veins have valves that open and close in response to the blood flow. When the left ventricle of the heart pushes blood out into the aorta, it produces the high pressure pulse of the heartbeat and pushes blood throughout the body. Between heartbeats, there is a period of low blood pressure. During this period blood in the veins is affected by gravity and wants to flow downward. The valves in the veins prevent this from happening. Varicose veins start when one or more valves fail to close. The blood pressure in that section of vein increases, causing additional valves to fail. This allows blood to pool and stretch the veins, further weakening the walls of the veins. The walls of the affected veins lose their elasticity in response to increased blood pressure. As the vessels weaken, more and more valves are unable to close properly. The veins become larger and wider over time and begin to appear as lumpy, winding chains underneath the skin. Varicosities can also develop in the deep veins. Varicose veins in the superficial veins are called primary varicosities, while varicose veins in the deep veins are called secondary varicosities.

Causes & Symptoms

Varicose veins have a number of different causes; lifestyle and hormonal factors play a role. Some families seem to have a higher incidence of varicose veins, indicating that there may be a genetic component to this disease. Varicose veins are progressive; as one section of a vein weakens, it causes increased pressure on adjacent sections of the vein. These sections often develop varicosities. Varicose veins can appear following pregnancy, thrombophlebitis, congenital blood vessel weakness or obesity, but they are not limited to these conditions. Oedema of the surrounding tissue, ankles, and calves is not usually a complication of primary (superficial) varicose veins. When oedema develops, it usually indicates that the deep veins may have varicosities or clots.

Varicose veins are a common problem. The symptoms can include aching, pain, itchiness and burning sensations, especially when standing. In some cases, with chronically bad veins, there may be a brownish discoloration of the skin or ulcers (open sores) near the ankles. A condition that is frequently associated with varicose veins is spider-burst veins. Spider-burst veins are very small veins that are enlarged. They may be caused by back-pressure from varicose veins, but can be caused by other factors. They are frequently associated with pregnancy and there may be hormonal factors associated with their development. They are primarily of cosmetic concern and do not present any medical concerns.

Diagnosis

Varicose veins can usually be seen. In cases where varicose veins are suspected, a doctor may frequently detect them by palpation (pressing with the fingers). The doctor will examine the veins while the patient is first in a standing position and a second time while the patient is lying down. X rays or ultrasound tests can detect varicose veins in the deep and perforator veins and rule out blood clots in the deep veins. A handheld Doppler instrument is now the preferred diagnostic tool for evaluating the leg veins.

Treatment

There is no cure for varicose veins. Treatment falls into two classes: relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This pressure keeps the veins from stretching and limits pain. Other measures include sitting down, using a footstool to support the feet when sitting, avoiding standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins. Exercise such as walking, cycling and swimming is beneficial. When the legs are active, the leg muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms but does not stop the disease.

Herbal therapy can be helpful in the treatment of varicose veins. Essential oils of cypress and geranium or extracts from horse chestnut seeds (Aesculus hippocastanum) are massaged into the legs, stroking upwards toward the heart. Application to broken skin and massage directly on the varicose veins should be avoided. Horse chestnut may also be taken orally and biothavenoids are used to increase vascular stability.

Drinking fresh fruit juices, particularly those of dark coloured berries (such as cherries, blackberries and blueberries) can help tone and strengthen the vein walls. The enzyme bromelain, found in pineapple juice, can aid in the prevention of blood clots associated with the pooling of blood in the legs.

Deep breathing exercises performed while lying down with the legs elevated can assist gravity in circulating blood from the legs. The flow of fresh blood into the legs can help relieve any pain.

Conventional Treatment

Surgery can be used to remove varicose veins from the body. It is recommended for varicose veins that are causing pain or are very unsightly, and when haemorrhaging or recurrent thrombosis appear.

Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein.

Two new treatments have been developed since 1999 that are much less invasive than surgery. One is called radio frequency closure, or the closure technique, which causes the vein to contract and seal itself shut. The nearby veins then take over the flow of venous blood from the legs.

The second new treatment is called the endovascular laser procedure, which heats the varicose vein and seals it shut.

Prevention

While genetic factors play a significant role in the development of varicose veins, swimming and other exercises to increase circulation in the legs help to prevent varicose veins. Preventive measures are especially important during pregnancy, when the additional weight of the foetus and placenta can exert pressure on the mother's legs and feet.